From fibrosis regression to recompensation: bibliometric and clinical evidence mapping of disease modification in cirrhosis.

BACKGROUND: The Baveno VII consensus formally defined cirrhosis recompensation in 2022, marking an important milestone in the transition of cirrhosis management from complication control toward disease modification. This concept did not emerge abruptly but was built on decades of research concerning etiological control, fibrosis regression, portal hypertension control, liver function recovery, and reversal of decompensation. However, the evolution of these knowledge domains, the key milestones shaping the field, and the clinical or mechanistic directions that should be prioritized remain unclear. This study used bibliometric analysis to map the development and trends of cirrhosis recompensation-related research, with emphasis on recent advances and future directions. METHODS: Relevant publications (up to May 31, 2026) were retrieved from the Web of Science Core Collection (WoSCC) and PubMed. Bibliometric visualization and network analyses were performed using CiteSpace, VOSviewer, bibliometrix, R, and Python to examine publication trends, global collaborations, core journals, author networks, co-cited references, keyword evolution, citation bursts, and randomized controlled trial (RCT) evidence mapping. RESULTS: A total of 588 WoSCC publications and 168 PubMed RCT publications were included. The field showed a three-stage evolution: complication control and survival prolongation; etiology-directed therapy and fibrosis regression; and recompensation-centered disease modification after Baveno VII. The United States and China were leading contributors, while Journal of Hepatology and Hepatology were central journals. Co-citation and keyword analyses highlighted antiviral therapy, fibrosis regression, portal hypertension, and recompensation as major knowledge themes. Further within-WoSCC mapping of the 31-publication RCT subset showed that no publication evaluated formal Baveno VII recompensation as an explicit endpoint. Complementary analysis of the 168 PubMed RCT publications showed that recompensation was not evaluated as an endpoint even among publications reporting follow-up beyond 48 weeks, indicating that this gap could not be attributed solely to short follow-up. CONCLUSION: This bibliometric analysis delineates the evolving landscape of cirrhosis recompensation-related research, characterized by a transition from complication control to disease modification and an increasing focus on recompensation after Baveno VII. Persistent gaps in RCT evidence, especially regarding recompensation endpoints and long-term disease-modification outcomes, underscore the need for continued high-quality clinical and translational studies in this field.